Lumbar puncture must it be preceded by the ocular fundus? Misconceptions and bad practices at the University Hospital of Brazzaville

Abstract

Background: The ocular fundus is the basis for the diagnosis of eye posterior segment lesions. Increasing the pressure of the cerebrospinal fluid that surrounds the optic nerve, whatever the cause, can lead to papilledema which signing intra cranial hypertension. The ophthalmology department of the University Hospital of Brazzaville (UHB) performs about twenty ocular fundus a week. It is not uncommon to read the ocular fundus to exclude intra cranial hypertension and then perform a lumbar puncture.

Objective: To remember that the intra-cranial hypertension does not mean that there is a risk of cerebral engagement.

Design: Transversal and analytical study.

Subjects: Hospitalised patients’.

Results: A total of 35 applications form were read. All (100%) had as indication of ocular fundus to exclude intra-cranial hypertension for achieving a lumbar puncture.

Conclusion: Confusion between intra-cranial hypertension and the risk of cerebral engagement is still common at the UHB. This has the effect of delaying or not realising the lumbar puncture which is the basis for the diagnosis of meningitis, increasing the morality associated with this serious disease. Do not make a lumbar puncture pending ocular fundus is a medical error that can be fatal for the patient.